« Obama takes heat from other side of immigrant healthcare debate | Main | After all the fuss, public health plan covers few »
Reader questions on House healthcare bill
By admin | November 1, 2009
latimes.com
HEALTHCARE Q & A
How Nancy Pelosi’s healthcare bill would affect taxes, Medicare prescription drug benefits, and more.
By Kim Geiger and James Oliphant
November 1, 2009
Reporting from Washington
Some reader questions on the national healthcare debate, focusing on the House bill unveiled Thursday by Speaker Nancy Pelosi (D-San Francisco):
Would the House Democrats’ bill raise my taxes more than the other bills making their way through Congress?
It depends on your income. The House bill would impose a surcharge on individuals who make more than $500,000 and couples who make more than $1 million. The previous House bill would have imposed the surcharge on individuals who make $280,000 and families that make $350,000. The current bill also would impose a tax of 2.5% of income for those who make more than $250,000 and fail to purchase health insurance.
How would the bill affect my prescription drug benefits under Medicare?
The bill would speed the closing of the Medicare Part D “doughnut hole” — the coverage gap that occurs when a patient’s prescription costs exceed a certain yearly amount. Over time, this bill would create a 50% discount for prescription drugs bought in the doughnut hole. That process would be completed in 2019 — five years earlier than proposed in the original House bill. The bill also would require the Health and Human Services secretary to negotiate for Medicare drug prices.
Why do insurers say this bill would raise healthcare costs?
Insurers are not happy that the bill includes a “public option,” a government-run plan that would be funded through an increased payroll tax for those who choose it. The public option would compete with private options in a regulated insurance exchange. Insurers say the public option will disrupt the healthcare market and could force some companies out of business. The bill also ends insurers’ exemption from antitrust laws that prohibit price-fixing, another element that they say could drive up costs.
How would the bill affect small businesses?
It would exempt more small businesses from a requirement to provide insurance benefits to employees. Employers with yearly payroll costs of less than $250,000, compared with $500,000 under the previous House bill, would be exempt from the requirement.
What parts of the bill would take effect as soon as it became law?
The bill would immediately eliminate lifetime coverage limits and rescission, the process an insurer uses to cancel a policy because the policyholder failed to disclose a preexisting condition.
In addition:
* People could keep their COBRA plans until the insurance exchange designed to offer affordable options is in place.
* Young people could stay on their parents’ insurance plans until they turn 27.
* Co-pays and deductibles for preventive services to Medicare patients would be eliminated.
* It would create a temporary insurance program for people who have been uninsured or denied coverage due to a preexisting condition.
I keep hearing that none of the Democratic healthcare bills would cover everyone. Who won’t be covered?
Under the most recent Senate version of the bill, people who don’t earn as much as four times the federal poverty level — amounting to $43,320 for an individual or $88,200 for a family of four — would be offered government assistance to buy insurance. But there would be no assistance for people who earn slightly more, though they could apply for an exemption from the insurance requirement if they can prove that the most inexpensive policy they could buy would exceed 8% of their income. That’s why experts have estimated that 3% to 6% of those eligible would remain uninsured.
Would a “public option” make it possible for everyone to be covered?
A so-called public option could make affordable insurance more accessible to those whose incomes are above the subsidy limit, but it is not likely that everyone would be covered.
The House bill, which does contain a public option, is estimated to cover about 97% of those eligible, more people than the Senate Finance Committee bill, which does not include a public option and would cover 94% of the population.
It is also possible that a public option would include a “firewall” that would prevent some people from enrolling — specifically those who work at a company that already offers coverage, even if that policy is not affordable for the employee.
I work at a small business, and my employer doesn’t offer health benefits. Will healthcare reform require my employer to cover me?
It depends on the size of the business, but many small businesses are exempt in the House and Senate bills. The final Senate bill is likely to exempt businesses with fewer than 50 employees from a mandate to offer coverage. The House bill exempts or reduces the requirement for businesses that have yearly payrolls of less than $400,000.
I have been denied health insurance because of a preexisting condition. Will any of these bills guarantee that I can buy insurance?
The bills appear to explicitly prohibit an insurer in the individual marketplace from denying you coverage because of your health status, regardless of whether you have been denied coverage in the past.
Of course, the bills do not guarantee you will be able to find an affordable policy.
And under the bills as they stand now, insurers will still be able to price policies based on your age or past tobacco use.
Some Democrats have proposed ending the insurance industry’s antitrust exemption. What exactly is that?
A 1945 law prevented the federal government from regulating all forms of insurance, leaving that duty to the states. As a result, the law also shielded insurers from federal antitrust laws that prohibit price-fixing and collusion. This is seen as a problem for residents in many areas where only one or two health insurers operate. Rather than go to a neighboring state where another insurer might be offering a better deal, residents are forced to choose between the insurers that are regulated by their state government. Some Democrats are proposing to repeal a portion of the law that relates to health insurers specifically.
Some Republicans have proposed allowing insurers to sell plans across state lines. Can’t they do that already?
A proposal to allow this was part of the bill that passed in the Democrat-controlled Senate Finance Committee last week. Republicans, however, have been the ones arguing the loudest in support of the idea. Currently, a resident in one state cannot buy a policy offered in another state because it would not meet state requirements and there would be no government regulator to ensure that the policy was honored. If the law were changed to allow interstate sales of health insurance, this could open the industry to federal antitrust laws because an interstate insurance regime would have to be regulated by the federal government.
What are some other proposals for increasing competition?
The one that draws the most attention is the “public option” — a government-run health insurer. Proponents say such an entity could offer cheaper insurance rates because it could deliver healthcare services in a more cost-effective way, particularly if it paid doctors at the same rate, or slightly higher, than Medicare does. Some members of Congress favor private, member-owned cooperatives that they say would compete with insurers without government involvement. And some believe that simply requiring all residents to buy insurance will give insurers enough incentive to compete for those new customers.
What about allowing national insurance plans?
That’s another proposal that proponents say would give consumers more choices and drive down premium costs. A provision in the Senate Finance Committee healthcare bill would allow insurers to offer national plans that would compete with state-based ones. Critics say such plans would evade tougher state regulations. The bill does allow states to opt out of the national plans, but some question whether states would be willing to do so if it meant preventing residents from buying less expensive plans that don’t meet state standards.
How can we be sure that there will be no rationing of healthcare or pharmaceuticals under the bills being considered in Congress?
Democrats argue that there is rationing in the current healthcare system, in part because insurance companies can rate consumers on the basis of preexisting medical conditions or drop them if they get sick. Those practices would be outlawed as part of the current legislation. As for pharmaceutical coverage, it’s possible that some consumers could end up with more coverage for prescription drugs than they have now.
Why is that?
It is likely that private companies seeking to participate in the new insurance exchanges — which would be created to help lower-income consumers — would have to offer prescription drug coverage as part of their essential benefits package. That could mean new coverage options for people who right now can’t afford such plans. At the same time, some consumers who obtained insurance through the exchanges might have to buy drug coverage they did not want or need — if they had other options for buying low-cost drugs, for example.
Will I have to pay more for my pharmaceuticals if I buy insurance through an exchange?
That would depend on what level of plan you chose. Under a less expensive plan, you would probably have to cover the cost of your prescription drugs until you reached a set deductible, something like $100 or $250. (This is separate from your overall insurance deductible.) At that point, your insurance would cover some or most of the cost. If you purchased a higher-priced plan, it’s likely there would be no deductible, and perhaps no co-pays either.
What about prescriptions under Medicare?
The overhaul proposals in Congress improve the drug benefit by reducing the so-called coverage gap or doughnut hole that exists for recipients of Medicare Part D, which affects about 4 million seniors each year. Under the $80-billion deal struck with the pharmaceutical industry, the prices of drugs that fall within the gap would be slashed by 50%.
Topics: Uncategorized | No Comments »
Comments are closed.